1. The Policy Landscape

1.1 Origins and Development

Direct Payments (DPs) were introduced under the Community Care (Direct Payments) Act 1996, aiming to shift control from local authorities to individuals requiring social care support. The underlying principle was to promote personal autonomy by allowing recipients to manage their own care arrangements rather than relying on traditional council-commissioned services (Glasby, 2014). The Care Act 2014 reinforced this policy by making personal budgets, including DPs, the preferred option for adult social care (Baxter, Wilberforce, & Glendinning, 2019).

Initially, DPs were restricted to individuals with physical disabilities, but legislative changes have expanded eligibility to older adults, people with learning disabilities, and those with mental health needs (Lymbery, 2017). Despite these reforms, uptake remains low, with only around 28.5% of eligible individuals choosing DPs, signaling persistent systemic barriers (Slasberg, Beresford, & Schofield, 2022).

1.2 Variation Between Areas

Despite national guidelines, significant discrepancies exist in how local authorities implement DPs. A study by Spandler (2004) found that some councils actively facilitate access to DPs, while others impose restrictive administrative hurdles that discourage uptake. According to the Centre for Care (2024), uptake rates vary regionally, with some areas, such as Somerset, reporting over 30% participation, whereas others, particularly in the North East, see rates as low as 20%.

Wilberforce et al. (2017) argue that these disparities arise due to differing interpretations of the statutory guidance within local authorities, exacerbated by financial pressures and risk-averse professional cultures.

1.3 Legal and Ethical Considerations

The Care Act 2014 mandates that personal budgets, including DPs, must be “sufficient to meet assessed needs” (Department of Health and Social Care, 2014). However, research by Hatton and Waters (2021) suggests that many councils allocate insufficient funds, rendering DPs impractical. Legal cases, such as R (Davey) v Oxfordshire County Council [2017] EWHC 354, have underscored the tendency of councils to impose arbitrary restrictions that undermine user choice (Simpson, 2018).

From an ethical standpoint, Beresford (2016) critiques how risk-averse policies erode the empowerment ethos of DPs. Instead of fostering independence, some councils use risk management rationales to justify budget reductions and service limitations (Glasby & Littlechild, 2016).

 2. Administrative Complexity

2.1 The Impact on DP Users

Direct Payments (DPs) were intended to provide individuals with more autonomy and control over their care. However, the administrative burden associated with managing a DP often discourages potential users, particularly those with disabilities, older adults, and carers already under strain (Baxter, Wilberforce, & Glendinning, 2019). Many recipients find the system difficult to navigate due to extensive paperwork, financial reporting, and employment responsibilities (Hatton & Waters, 2021).

Managing a DP often requires individuals to become an employer, which includes recruiting, hiring, and managing Personal Assistants (PAs), running payroll, complying with employment laws, and maintaining meticulous financial records (Needham, 2014). Research by Glasby and Littlechild (2016) found that these administrative expectations deter individuals who might otherwise benefit from a DP.

A report by Think Local Act Personal (TLAP) (2023) emphasises that many DP recipients feel overwhelmed by these demands, particularly those with cognitive impairments or mental health conditions. This complexity is a key reason why older adults and people with learning disabilities have disproportionately low DP uptake compared to younger physically disabled individuals (Lymbery, 2017).

2.2 Strategies for Simplification

Several solutions have been proposed to reduce bureaucracy and improve accessibility for DP users:

1. Simplified Financial Monitoring
   The Local Government Association (LGA) (2022) argues that overly rigid financial monitoring processes create barriers to DP use. Some councils require excessive financial auditing that goes beyond what is needed for accountability. Simplified and proportionate monitoring systems could encourage more people to opt for DPs (LGA, 2022).
2. Third-Party Managed Accounts
   One effective solution is the introduction of managed accounts, where a third-party organisation handles payroll, financial reporting, and record-keeping for the DP user (Hatton, Waters, & Routledge, 2022). This reduces stress for users who may not have the capacity to handle financial administration but still wish to exercise choice and control.
3. Providing Better Support and Training
   A survey by Waters and Hatton (2021) found that many DP users lack adequate training and information to manage their budgets effectively. Investing in accessible training programs, including online resources and helplines, can empower individuals to use their DP more confidently.
4. Digital Solutions for DP Management
   The introduction of online platforms for payroll management and financial reporting has been recommended by Needham and Carr (2009). These platforms reduce paperwork, automate record-keeping, and ensure compliance with council regulations.

A case study from Surrey County Council illustrates how streamlining administrative processes increased DP uptake in the region. By reducing paperwork, offering managed account options, and providing user-friendly digital tools, Surrey has seen an improvement in user satisfaction and a reduction in complaints about DP complexity (Surrey County Council, 2023).

Addressing administrative complexity is critical to increasing the uptake and effectiveness of DPs. Without meaningful reform, many individuals will continue to opt for traditional services due to the overwhelming burden of financial management. By simplifying financial oversight, introducing managed accounts, investing in training, and leveraging technology, local authorities can make DPs more accessible and fulfilling for DP users.

 3. Workforce Challenges

3.1 Recruitment and Retention Difficulties

One of the most significant barriers to Direct Payments (DPs) is the shortage of Personal Assistants (PAs). Individuals who receive DPs often struggle to recruit and retain suitable support workers, undermining the potential for personalised care (Baxter, Glendinning, & Clarke, 2019).

A report by Skills for Care (2023) found that:

• The PA workforce is ageing, with fewer younger workers entering the sector.
• Turnover rates exceed 35%, meaning many DP users frequently lose their support staff.
• PA roles are often poorly paid, making it difficult to attract and retain workers.

The COVID-19 pandemic further exacerbated workforce shortages, as many PAs left the sector due to health risks, burnout, and job insecurity (Hussein, 2021). The lack of employment benefits, such as sick pay and pensions, discourages potential recruits from choosing PA roles (Rubery, 2020).

3.2 Pay Disparities

A major issue contributing to the workforce crisis is wage disparity. Research by Hatton and Waters (2022) highlights that PA wages are often lower than those of agency care workers, even though DPs were intended to provide competitive alternatives to traditional services.

According to the Institute for Public Policy Research (IPPR) (2022):

• PA salaries often fall below the national living wage once employment costs (e.g., holiday pay, National Insurance) are deducted.
• Many DP users cannot increase PA pay rates due to local authority budget constraints.
• This wage disparity leads to high turnover rates and difficulty in filling vacancies, particularly in rural areas where fewer people are available to take on PA roles.

3.3 Training and Professional Development

Unlike agency-employed care workers, many PAs lack access to structured training and career development. This creates challenges for both DP users and professionals, as untrained PAs may struggle with complex care tasks (Glendinning et al., 2016).

A survey conducted by Think Local Act Personal (TLAP) (2023) found that:

• 60% of DP users wanted their PAs to receive better training in specialist areas such as dementia care, mental health, and learning disabilities.
• Only 30% of PAs had received formal training, compared to 85% of agency carers.
• Some councils do not allow DP budgets to be used for PA training, further limiting workforce development.

Expanding access to free or subsidised training could enhance PA retention by making the role more attractive and rewarding (Needham & Carr, 2009).

3.4 Successful Workforce Initiatives

Despite these challenges, some local authorities and organisations have pioneered successful models for strengthening the DP workforce:

Somerset Micro-Enterprise Programme

• Somerset County Council has invested in micro-enterprises, small self-employed care providers who operate independently or within networks.
• This approach has expanded workforce capacity and given DP users greater choice (Wilberforce et al., 2017).

Isle of Wight PA Hub

• The Isle of Wight PA Hub provides a PA-matching service, ensuring DP users can find trained support workers.
• The hub also offers training, peer support, and employment guidance to improve retention (Holt-Lunstad et al., 2021).

National PA Register

• Some regions have introduced PA Registers, where DP users can advertise roles and connect with pre-vetted care workers (Skills for Care, 2023).

Allowing Family and Friends to be PAs

• In some areas, councils allow DP users to employ family members or trusted friends as PAs.
• Research by Beresford (2016) suggests that this improves continuity of care and provides a more stable workforce.

The shortage of PAs is one of the biggest obstacles to making DPs work effectively. To address this issue, councils should:

• Increase PA pay rates to ensure wages are competitive.
• Invest in training programs to upskill the workforce.
• Expand recruitment initiatives, including PA hubs and digital platforms.
• Support micro-enterprises and self-employed PAs as a viable alternative to traditional care agencies.

If these measures are not taken, the DP model risks failing due to a lack of available personal assistants and support options.

4. Lack of Flexibility in Spending Rules

4.1 Case Study Restrictive Policies

Direct Payments (DPs) were introduced to enable individuals to arrange and manage their care in a way that suits their needs. However, many local authorities impose restrictive spending rules that contradict the principles of personalisation (Slasberg & Beresford, 2022). These restrictions often prevent DP users from using funds for non-traditional support options, such as therapeutic interventions, community-based services, and informal care arrangements (Glendinning, 2016).

A case study from a Welsh local authority (Hatton & Waters, 2021) highlights the negative impact of these restrictions:

• The council prohibited DP users from employing family members, despite strong evidence that family-provided care improves continuity and well-being (Arksey & Glendinning, 2007).
• A DP user was denied funding for hydrotherapy, even though it was recommended as an essential part of their care plan.

Think Local Act Personal (TLAP) (2023) found that council policies often restrict the use of DPs in ways that undermine personal choice. Many councils insist on traditional home care services, rather than allowing users to purchase innovative support that may better meet their needs (Waters & Hatton, 2022).

4.2 Expanding Options

To address these challenges, local authorities should adopt a more flexible and person-centred approach to DP funding. Several strategies have been proposed:

Broadening Permissible Uses
The Care Act 2014 (Department of Health and Social Care, 2014) supports the principle that DPs should be flexible and tailored to individual needs. However, many councils impose restrictions beyond the legal framework, limiting what people can purchase (Simpson, 2018). A study by Lymbery (2017) suggests that councils should allow DPs to be used for:

• Therapies and social activities that improve well-being.
• Equipment and assistive technology that promotes independence.
• Non-traditional care models, such as shared personal assistance.

Promoting Individual Service Funds (ISFs)
Some individuals struggle with the responsibilities of managing a DP, but they still want flexibility. Individual Service Funds (ISFs) allow a third-party provider to manage the budget while ensuring the person retains control (Hatton & Waters, 2022). Research shows that ISFs can:

• Reduce the administrative burden on DP users.
• Offer more choice in how care is arranged (Spandler, 2004).
• Improve budget sustainability, as they allow shared arrangements between ISF users.

Addressing Risk-Averse Decision-Making
Local authorities often restrict spending options due to perceived safeguarding risks (Ferguson, 2020). However, evidence suggests that excessive restrictions harm well-being by limiting access to social and therapeutic activities (Wilberforce et al., 2017). Councils should adopt a risk enablement approach, balancing safety with autonomy (Glasby & Littlechild, 2016).

4.3 Examples of Best Practice

Several regions have successfully adopted more flexible DP policies, leading to better outcomes for individuals:

Scotland’s Flexible Use Initiative (Care Inspectorate Scotland, 2023)

• Scottish local authorities have allowed wider spending options, such as group-based support and community-led care.
• Research found that DP users in Scotland report higher satisfaction compared to those in England (Hatton et al., 2022).

Somerset County Council’s Personalisation Approach

• Somerset relaxed its spending rules to allow greater choice in support services.
• DP uptake rose by 12% after these changes were introduced (Wilberforce et al., 2017).

Restrictive spending policies undermine the core principles of DPs, leading to reduced choice and poorer outcomes for individuals. Councils should:

• Expand the range of services DPs can be used for, including therapies and social support.
• Promote ISFs for people who need flexibility without the burden of financial management.
• Shift away from risk-averse policies, ensuring that safeguarding measures do not restrict autonomy.

By removing unnecessary barriers, DPs can fulfil their intended purpose: enabling people to live independently with choice and dignity.

5. Risk Aversion Among Professionals

5.1 How Attitudes Shape Uptake

Risk aversion among social care professionals is one of the most significant barriers to Direct Payments (DPs). While safeguarding concerns are important, overly cautious practices often result in professionals discouraging individuals from choosing DPs (Beresford, 2016).

Several studies highlight how social workers and care assessors tend to steer individuals towards traditional services instead of empowering them to make independent choices (Glasby & Littlechild, 2016). A report by the Social Care Institute for Excellence (SCIE) (2022) found that:

• Many social workers lack confidence in supporting DP users due to fears about accountability and safeguarding.
• Some professionals view DPs as too risky, particularly for individuals with mental health conditions or cognitive impairments.
• There is a culture of professional control, where practitioners feel more comfortable with council-managed care services rather than self-directed support (Needham, 2014).

Risk-averse practices are often institutionally reinforced. The House of Lords Select Committee (2014) concluded that the implementation of the Mental Capacity Act 2005 had been undermined by “paternalistic and risk-averse cultures” in social care settings (Simpson, 2018). This has led to excessive gatekeeping, with professionals restricting access to DPs due to fears about mismanagement, fraud, or potential safeguarding failures (Slasberg & Beresford, 2022).

5.2 Shifting the Culture

To address risk aversion in DP decision-making, local authorities should focus on training, policy reforms, and professional development. Several key strategies have been identified:

Training and Professional Development

• Many social workers lack training on risk enablement (Carr, 2014).
• The SCIE (2022) report found that positive risk-taking should be integrated into professional education to ensure social workers understand how to balance autonomy with safeguarding.
• Training should focus on legal frameworks such as the Care Act 2014 and Mental Capacity Act 2005, both of which promote individual rights and personal autonomy (Ferguson, 2020).

Embedding Risk Enablement in Social Work Practice

• The Care Act 2014 encourages local authorities to promote well-being and choice in care decisions (Department of Health and Social Care, 2014).
• A study by Wilberforce et al. (2017) found that councils that adopt risk enablement policies report higher DP uptake and satisfaction.

Organisational Support for Social Workers

• Many social workers fear personal liability if something goes wrong with a DP arrangement (Needham & Carr, 2009).
• A report by the Local Government Association (LGA) (2022) highlights the importance of clear guidelines and leadership support to encourage proportionate risk-taking.

Co-Production with DP Users

• Involving DP users in social worker training can help professionals understand real-world benefits and challenges (Hatton & Waters, 2021).
• A Think Local Act Personal (TLAP) (2023) survey found that social workers who engaged directly with DP users were more likely to adopt a person-centred approach.

5.3 Examples of Good Practice

Several councils have successfully shifted their approach to risk in social care, demonstrating that risk enablement does not compromise safety:

Surrey County Council – Risk Enablement in Direct Payments

• Introduced risk enablement panels to support social workers in making balanced decisions.
• Developed training on proportionate risk assessment, leading to increased DP uptake (Surrey County Council, 2023).

Isle of Wight Council – Positive Risk-Taking Framework

• Encourages creative solutions to care needs, including self-managed support and community-led services.
• Social workers receive guidance on balancing risk with personal choice, resulting in a 15% increase in DP use (Waters & Hatton, 2022).

Risk aversion continues to undermine the effectiveness of DPs, despite clear legal and policy frameworks that support autonomy. To overcome this, local authorities must:

• Train social workers to embrace positive risk-taking.
• Support professionals in balancing safeguarding with choice.
• Create clear guidelines to reduce fear of accountability.
• Engage DP users in policy and training, ensuring their voices shape social work practice.

By adopting risk enablement strategies, councils can increase DP uptake and ensure individuals receive the personalised support they deserve.

 6. Market Development and Community-Led Solutions

6.1 Expanding the Market

A strong, diverse marketplace is essential for Direct Payments (DPs) to function effectively, providing users with meaningful choice and control over their care and support. However, many local authorities lack a well-developed market, limiting the options available to DP recipients (Glasby & Littlechild, 2016). Research by Baxter, Glendinning, & Clarke (2019) found that DP users in underdeveloped care markets often experience difficulty in sourcing Personal Assistants (PAs) and specialist support services, leading some to abandon DPs altogether.

A report by the Centre for Welfare Reform (Hatton, 2022) found that:

• In some local authorities, less than 10% of social care funding is spent through DPs due to market limitations.
• DP users often find better availability of care services in urban areas compared to rural locations, where options are restricted.
• The rise of digital platforms has created new opportunities to match DP users with providers, but uptake remains slow due to council-led resistance to change.

A study by Ferguson (2020) found that the failure to stimulate a diverse market contradicts the aims of the Care Act 2014, which requires local authorities to support market development and ensure sufficient services are available for DP users.

6.2 Strategies for Market Growth

To create a more vibrant and responsive market, local authorities should adopt several key strategies:

Investment in Micro-Enterprises

• Small, self-employed care providers (often called micro-enterprises) can fill gaps in the market by offering more flexible, personalised care (Wilberforce et al., 2017).
• A case study from Somerset County Council found that investment in micro-enterprises led to a 12% increase in DP uptake by expanding the range of services available (Needham & Carr, 2009).

Promoting Community-Led Initiatives

• Encouraging cooperative care models and peer support networks allows individuals to design their own support systems (Hatton & Waters, 2021).
• Research by Slasberg & Beresford (2022) found that community-led approaches improve service quality and promote greater independence for DP users.

Digital Solutions to Improve Accessibility

• Online care-matching platforms help DP users find PAs, support workers, and community services, but many councils have been slow to adopt them (Skills for Care, 2023).
• A case study from Surrey County Council (2023) demonstrated that integrating digital matching tools led to a 25% increase in successful DP recruitment.

Creating PA Hubs and Workforce Development

• PA Hubs, such as those in the Isle of Wight, provide a centralised resource for recruitment, training, and support, ensuring that DP users can find and retain skilled care workers (Waters & Hatton, 2022).

6.3 Examples of Effective Market Development

Several local authorities and organisations have demonstrated success in expanding care markets:

Somerset Micro-Enterprise Programme

• This initiative supports small-scale care providers, giving DP users greater choice and more personalised options (Wilberforce et al., 2017).

The Isle of Wight PA Hub

• A one-stop resource where DP users can find, train, and retain PAs.
• Resulted in a 15% reduction in recruitment difficulties for DP users (Skills for Care, 2023).

Surrey County Council’s Digital Direct Payments Strategy

• Introduced an online marketplace for DP users to connect with care providers.
• Increased user satisfaction rates by 30% (Surrey County Council, 2023).

For DPs to achieve their intended goal of empowering individuals, local authorities must:

• Invest in micro-enterprises and small-scale care providers.
• Promote digital solutions to improve service accessibility.
• Encourage community-led support networks to expand market diversity.
• Develop PA Hubs to improve workforce recruitment and retention.

Without these measures, DPs risk being underutilised, and DP users will continue to struggle to find the support they need.

7: Funding Issues

7.1 Challenges in Funding Allocation

One of the most significant barriers to the effective use of Direct Payments (DPs) is insufficient funding, which limits the ability of individuals to purchase appropriate care and support (Hatton & Waters, 2021). While the Care Act 2014mandates that DPs should be “sufficient to meet assessed needs” (Department of Health and Social Care, 2014), evidence suggests that budget cuts and underfunding have made DPs increasingly unworkable for many users (Slasberg & Beresford, 2022).

A report from The King’s Fund (2023) highlights that:

• Only 26% of people who draw on adult social care use DPs, a decline from previous years.
• Many local authorities have reduced DP allocations, citing financial constraints and budget cuts.
• DP users often cannot pay competitive wages for Personal Assistants (PAs), leading to workforce shortages (Skills for Care, 2023).

Research by Glasby et al. (2020) found that funding decisions are often driven by cost-saving pressures, rather than individual need, resulting in inadequate personal budgets that fail to support independent living.

7.2 Addressing Funding Challenges

To ensure that DPs fulfil their intended purpose, local authorities must implement fair and transparent funding mechanisms. Several strategies have been recommended:

Comprehensive Needs Assessment

• Local authorities should conduct accurate and holistic assessments to determine the true cost of meeting an individual’s needs (Baxter, Glendinning, & Clarke, 2019).
• A report by Wilberforce et al. (2017) found that many councils underestimate care costs, leading to budgets that do not cover the cost of essential services.

Transparent Budget Setting

• DP allocations should be transparent and consistent, ensuring that individuals understand how their budgets are calculated and have a right to challenge decisions (Simpson, 2018).
• The Local Government Association (LGA) (2022) recommends a standardised funding formula to prevent unfair variations between councils.

Regular Budget Reviews

• Personal budgets should be reviewed regularly to reflect changes in an individual’s circumstances or care needs (Hatton & Waters, 2022).
• A study by Lymbery (2017) found that lack of flexibility in budget adjustments prevents DP users from adapting their care plans over time.

Joint Health and Social Care Funding

• A joint funding model, where NHS Continuing Healthcare and local authority social care funding are combined, could improve support for people with complex needs (Ferguson, 2020).
• A pilot program in Manchester found that integrating health and social care budgets led to better outcomes for DP users (Glasby, 2014).

Advocacy and Support for DP Users

• Many DP users struggle to challenge funding decisions, and access to independent advocacy is essential (Needham, 2014).
• Think Local Act Personal (TLAP) (2023) recommends expanding advocacy services to ensure that individuals can negotiate for appropriate funding levels.

7.3 Examples of Effective Funding Strategies

Several regions have implemented more sustainable DP funding models:

Somerset County Council – Budget Transparency Model

• Introduced a clear funding formula, ensuring DP users understand how their budget is calculated.
• Led to higher satisfaction rates and reduced complaints about budget sufficiency (Wilberforce et al., 2017).

Manchester Integrated Health and Social Care Budget Pilot

• Combined NHS and social care funding, allowing greater flexibility in DP allocations.
• Resulted in better continuity of care and higher PA retention rates (Glasby, 2014).

Scotland’s Self-Directed Support (SDS) Reform

• Introduced fairer budget-setting processes that align funding with assessed needs.
• DP users in Scotland report higher levels of control over their care plans compared to England (Hatton & Waters, 2021).

Underfunding of DPs remains a critical issue, limiting individuals’ ability to access meaningful, person-centred support. To address this:

• Funding should be allocated based on assessed needs, not budgetary constraints.
• Budget calculations must be transparent, with clear explanations and the ability to challenge decisions.
• Joint health and social care funding models should be expanded to support those with complex needs.
• Regular budget reviews should ensure that DP allocations reflect changing circumstances.

Without these reforms, DPs risk becoming a symbolic policy rather than a functional tool for empowerment.

Despite the intended benefits of Direct Payments (DPs) – empowering individuals to have greater choice and control over their care – this book has highlighted numerous systemic barriers that continue to hinder their effectiveness.

Policy and Implementation Variability

• Significant disparities between local authorities result in unequal access to DPs (Wilberforce et al., 2017).
• Some councils actively promote DPs, while others place bureaucratic hurdles that discourage uptake (Hatton & Waters, 2021).

Administrative Burdens

• Many DP users find the paperwork and employer responsibilities overwhelming (Needham, 2014).
• Excessive financial monitoring and lack of support services create additional barriers (Glasby & Littlechild, 2016).

Workforce Limitations

• Recruiting and retaining Personal Assistants (PAs) remains a major challenge (Skills for Care, 2023).
• Low wages and job insecurity discourage people from entering PA roles, leading to chronic workforce shortages (Hussein, 2021).

Restrictive Spending Rules

• Many councils impose rigid restrictions on how DPs can be used, contradicting the principle of personalisation (Slasberg & Beresford, 2022).
• DP users are often prevented from employing family members, accessing non-traditional therapies, or funding community-based support (Hatton & Waters, 2021).

Professional Risk Aversion

• Social care professionals frequently discourage the use of DPs, citing safeguarding concerns (Ferguson, 2020).
• The culture of risk aversion leads to gatekeeping practices, reducing DP uptake (House of Lords Select Committee, 2014).

Market Development Gaps

• Many areas lack a well-developed care market, leaving DP users unable to find suitable services (Baxter et al., 2019).
• The absence of PA networks and limited micro-enterprises restrict service availability (Wilberforce et al., 2017).

Funding Constraints

• Councils often underfund personal budgets, making it difficult for DP users to purchase adequate support (The King’s Fund, 2023).
• Budget cuts have resulted in many DP users receiving insufficient funding to hire quality care (Glasby et al., 2020).

To unlock the full potential of DPs, local authorities must commit to systemic reforms that remove barriers and promote genuine choice and control. The following recommendations emerge from the findings of this book:

Standardising DP Policies Across Local Authorities

• Implement consistent national guidelines to ensure equitable access to DPs (LGA, 2022).
• Reduce unnecessary bureaucracy that discourages uptake (Glasby & Littlechild, 2016).

Simplifying Administrative Processes

• Expand third-party managed accounts to reduce the administrative burden on users (Hatton & Waters, 2022).
• Introduce digital solutions for payroll management and financial tracking (Surrey County Council, 2023).

Strengthening the PA Workforce

• Increase PA wages to ensure competitive pay rates (Skills for Care, 2023).
• Develop PA training and professional development programs to enhance workforce retention (Wilberforce et al., 2017).

Enhancing Flexibility in Spending Rules

• Allow DPs to fund therapeutic services, community support, and non-traditional care options (Slasberg & Beresford, 2022).
• Promote Individual Service Funds (ISFs) for those who require a flexible but supported approach (Hatton & Waters, 2021).

Shifting Social Work Culture Towards Risk Enablement

• Train social workers to embrace positive risk-taking and person-centred decision-making (SCIE, 2022).
• Develop risk enablement policies that balance safeguarding with autonomy (Ferguson, 2020).

Developing a Thriving Market for Care and Support

• Invest in micro-enterprises and PA hubs to expand service options (Needham & Carr, 2009).
• Use technology to match DP users with suitable care providers (Surrey County Council, 2023).

Ensuring Adequate and Sustainable Funding

• Align DP budgets with assessed needs, rather than arbitrary cost-cutting (The King’s Fund, 2023).
• Implement joint funding models with health services to improve support for those with complex needs (Glasby, 2014).

Direct Payments remain a powerful tool for personalisation, but they will only succeed if systemic barriers are addressed. If local authorities implement the evidence-based solutions outlined in this paper, DPs can fulfil their original promise – allowing people to live independently, make meaningful choices, and receive the care they need on their own terms.

Chris Watson
Chris Watson is the founder of Self Directed Futures, the Chair of SDS Network England and co-founder of LDA Commissioners Network. With extensive experience in strategic commissioning and change management, Chris advocates for innovative, community-led approaches to adult social care.

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